冻干重组人脑利钠肽联合低分子肝素钙治疗重症肺心病心力衰竭的疗效观察

Curative effect of recombinant human brain natriuretic peptide combined with low molecular heparin calcium on severe cor pulmonale complicated with heart failure

目的观察冻干重组人脑利钠肽(rh BNP)联合低分子肝素钙治疗重症肺心病心力衰竭的疗效及安全性。方法采用随机数字表法将70例重症肺心病心力衰竭患者,分为治疗组(35例)和对照组(35例),对照组给予常规治疗,治疗组在常规治疗基础上加用冻干rh BNP联合低分子肝素钙治疗。观察2组患者呼吸困难的程度、浮肿情况、肺部啰音、肝脏情况、24 h尿量、心率、右心室舒张末内径(RVEDD)、肺动脉压力(PAP)、左室射血分数(LVEF)、动脉血氧分压(Pa O2)、动脉血二氧化碳分压(Pa CO2)、氨基末端脑钠肽前体(NT-pro BNP)、D-二聚体及纤维蛋白原(FIB)等。结果治疗后对照组治疗有效率为80.0%,治疗组为91.4%,2组比较差异无统计学意义(P>0.05)。治疗7 d后,患者呼吸困难明显减轻,浮肿消退、肺部啰音减少>80%、肝脏回缩、24 h尿量增多、心率下降。治疗组RVEDD及PAP均明显降低,LVEF明显提高,Pa O2上升,Pa CO2下降,NT-pro BNP降低,D-二聚体、FIB下降,与对照组比较,差异均有统计学意义(P<0.05)。结论 rh BNP联合低分子肝素钙治疗重症肺心病心力衰竭疗效显著,值得基层医院推广应用。

Objective To evaluate the efficacy and safety of recombinant human brain natriuretic peptide（ rh BNP） combined with low-molecular-weight heparin calcium on severe cor pulmonale with heart failure. Methods Seventy cases of severe cor pulmonale complicated with heart failure were randomly allocated to control group and treatment group with 35 cases in each group. Patients in control group received conventional therapy,while the patients in treatment group received recombinant brain natriuretic peptide combined with low molecular heparin calcium additionally. The degree of dyspnea, edema, pulmonary rale, heart rate, arterial blood gas analysis,pulmonary artery pressure（ PAP）,the levels of right ventricular end diastolic diameter（ RVEDD）,left ventricular ejection fraction（ LVEF）,Pa O2,Pa CO2,NT-pro BNP and D-dimer,fibrinogen（ FIB） were observed before and after seven-day treatment. Results The effective rate of control group was 80. 0 %,which was lower than that of treatment group（ 91. 4 %）. After seven-day treatment, dyspnea, edema, pulmonary rales and heart rate were improved in the two groups. The levels of Pa CO2,RVEDD,NT-pro BNP,PAP,D-dimer and FIB were decreased,and the levels of Pa O2,LVEF were increased significantly after treatment in treatment group. There was a significant difference between the treatment group and the control group（ P〈0. 05）. Conclusions Recombinant human brain natriuretic peptide combined with low molecular weight heparin calcium shows significant curative effects in treating severe cor pulmonale complicated with heart failure,which is worth widely applying in the primary hospitals.